Prospective Payment Integrity

JSON twin: https://www.healthaidb.com/software/prospective-payment-integrity.json

Company Name

Healthedge

Product URL

https://www.healtheedge.com/solutions/prospective-payment-integrity

Company URL

https://www.healtheedge.com

Categories

• administrative Operations
• payment Solutions
• revenue Cycle
• health Data Analytics
• payer Solutions
• cloud-based Solutions
• ai Clinical Documentation Integrity
• clinical Decision Support
• imaging Software
• Administrative
• Payment Integrity
• Claims Editing
• Reimbursement Pricing
• Analytics
• Payer Facing
• Cloud
• Ai

Summary

HealthEdge's Prospective Payment Integrity is a cloud-based platform that automates claims editing, reimbursement, and real-time analytics to prevent improper payments before they occur.

Description

HealthEdge's Prospective Payment Integrity, known as HealthEdge Source™, is a cloud-based platform designed to automate claims editing, reimbursement, and real-time analytics, enabling healthcare payers to prevent improper payments proactively. It integrates Medicare, Medicaid, and commercial reimbursement engines, offers rich editing libraries, and provides retroactive-change monitoring to centralize claims pricing, reduce vendor dependency, and improve transparency. The platform also delivers real-time analytics and platform access to enhance payment integrity operations.

Api Available

yes

Certifications

• HITRUST CSF Certification
• ISO 27001

Company Founding

2005

Company Offices

• United States
• India

Compliance

• HIPAA
• HITRUST CSF
• SOC 2
• ISO 27001

Customers

• HealthEdge Software

Data Residency

Supports deployment on public or private cloud (no region-specific residency details published)

Data Standards

• FHIR
• HL7 v2
• DICOM
• SNOMED
• ICD-10

Deployment Model

• SaaS
• on_prem
• hybrid

Features

• Pre-pay and post-pay claim editing
• CMS Medicare reimbursement management
• Medicaid reimbursement management
• Commercial contract configuration and modeling
• History-based editing library
• Custom edit development
• Retroactive Change Manager (automated monitoring and repricing)
• Real-time analytics and financial impact insights
• Platform access with transparency into payment workflow
• Centralized claims adjudication and business intelligence
• Integrated third-party content ecosystem
• Automated updates to pricing and rules

Id

SW1462

Integration Partners

• HealthEdge Software

Integrations

• HealthRules Payer
• Codoxo Unified Cost Containment Platform

Languages Supported

• English

Last Updated

2025-10-11

License

commercial

Market Segment

• enterprise
• smb

Optional Modules

• HealthEdge Source Analytics
• HealthEdge Source Professional Services
• HealthEdge Source Third-Party Integrations

Os Platforms

• Web

Pricing Details

Contact vendor for pricing information.

Pricing Model

enterprise_quote

Privacy Features

• BAA available
• Consent management
• Anonymization
• Data minimization

Product Code

SW1462

Product Name

Prospective Payment Integrity

Ratings

• 4.3 out of 5 stars (G2)

Regions Available

• United States

Related Urls

• https://elion.health/products/healthedge-prospective-payment- integrity

Release Year

2005

Security Features

• Encryption
• RBAC
• SSO/SAML
• Audit logs
• 2FA
• DLP

Specialties

• Payment Integrity
• Prospective/pre-pay Editing
• Reimbursement/pricing
• Medicare Reimbursement
• Medicaid Reimbursement
• Commercial Contract Modeling
• Claims Editing
• Retroactive Change Management
• Analytics & Bi
• Vendor Integration

Support Channels

• email
• phone
• chat
• ticketing
• community
• 24x7

System Requirements

Cloud-hosted (supports public and private cloud deployments); no customer on-prem hardware specified

Target Users

• health plan payers
• claims processors
• payment integrity analysts
• reimbursement managers
• policy/editing teams
• operations leaders
• finance/BI teams
• IT/integration teams
• professional services/consultants

Training Options

• documentation
• webinars
• live_online
• onsite
• certification

Type

product

User Reviews

• Such a fantastic tool to use and more things to know.
• You definitely need the proper training in order to perform your daily task.
• They keep in touch with the market dynamics and stay up to date with all the recent changes.

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "Prospective Payment Integrity",
  "company_name": "Healthedge",
  "product_url": "https://www.healtheedge.com/solutions/prospective-payment-integrity",
  "company_url": "https://www.healtheedge.com",
  "related_urls": [
    "https://elion.health/products/healthedge-prospective-payment- integrity"
  ],
  "product_code": "SW1462",
  "summary": "HealthEdge's Prospective Payment Integrity is a cloud-based platform that automates claims editing, reimbursement, and real-time analytics to prevent improper payments before they occur.",
  "description": "HealthEdge's Prospective Payment Integrity, known as HealthEdge Source™, is a cloud-based platform designed to automate claims editing, reimbursement, and real-time analytics, enabling healthcare payers to prevent improper payments proactively. It integrates Medicare, Medicaid, and commercial reimbursement engines, offers rich editing libraries, and provides retroactive-change monitoring to centralize claims pricing, reduce vendor dependency, and improve transparency. The platform also delivers real-time analytics and platform access to enhance payment integrity operations.",
  "categories": [
    "administrative Operations",
    "payment Solutions",
    "revenue Cycle",
    "health Data Analytics",
    "payer Solutions",
    "cloud-based Solutions",
    "ai Clinical Documentation Integrity",
    "clinical Decision Support",
    "imaging Software",
    "Administrative",
    "Payment Integrity",
    "Claims Editing",
    "Reimbursement Pricing",
    "Analytics",
    "Payer Facing",
    "Cloud",
    "Ai"
  ],
  "market_segment": [
    "enterprise",
    "smb"
  ],
  "target_users": [
    "health plan payers",
    "claims processors",
    "payment integrity analysts",
    "reimbursement managers",
    "policy/editing teams",
    "operations leaders",
    "finance/BI teams",
    "IT/integration teams",
    "professional services/consultants"
  ],
  "specialties": [
    "Payment Integrity",
    "Prospective/pre-pay Editing",
    "Reimbursement/pricing",
    "Medicare Reimbursement",
    "Medicaid Reimbursement",
    "Commercial Contract Modeling",
    "Claims Editing",
    "Retroactive Change Management",
    "Analytics & Bi",
    "Vendor Integration"
  ],
  "regions_available": [
    "United States"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "enterprise_quote",
  "pricing_details": "Contact vendor for pricing information.",
  "license": "commercial",
  "company_offices": [
    "United States",
    "India"
  ],
  "company_founding": "2005",
  "deployment_model": [
    "SaaS",
    "on_prem",
    "hybrid"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Pre-pay and post-pay claim editing",
    "CMS Medicare reimbursement management",
    "Medicaid reimbursement management",
    "Commercial contract configuration and modeling",
    "History-based editing library",
    "Custom edit development",
    "Retroactive Change Manager (automated monitoring and repricing)",
    "Real-time analytics and financial impact insights",
    "Platform access with transparency into payment workflow",
    "Centralized claims adjudication and business intelligence",
    "Integrated third-party content ecosystem",
    "Automated updates to pricing and rules"
  ],
  "optional_modules": [
    "HealthEdge Source Analytics",
    "HealthEdge Source Professional Services",
    "HealthEdge Source Third-Party Integrations"
  ],
  "integrations": [
    "HealthRules Payer",
    "Codoxo Unified Cost Containment Platform"
  ],
  "data_standards": [
    "FHIR",
    "HL7 v2",
    "DICOM",
    "SNOMED",
    "ICD-10"
  ],
  "api_available": "yes",
  "system_requirements": "Cloud-hosted (supports public and private cloud deployments); no customer on-prem hardware specified",
  "compliance": [
    "HIPAA",
    "HITRUST CSF",
    "SOC 2",
    "ISO 27001"
  ],
  "certifications": [
    "HITRUST CSF Certification",
    "ISO 27001"
  ],
  "security_features": [
    "Encryption",
    "RBAC",
    "SSO/SAML",
    "Audit logs",
    "2FA",
    "DLP"
  ],
  "privacy_features": [
    "BAA available",
    "Consent management",
    "Anonymization",
    "Data minimization"
  ],
  "data_residency": "Supports deployment on public or private cloud (no region-specific residency details published)",
  "customers": [
    "HealthEdge Software"
  ],
  "user_reviews": [
    "Such a fantastic tool to use and more things to know.",
    "You definitely need the proper training in order to perform your daily task.",
    "They keep in touch with the market dynamics and stay up to date with all the recent changes."
  ],
  "ratings": [
    "4.3 out of 5 stars (G2)"
  ],
  "support_channels": [
    "email",
    "phone",
    "chat",
    "ticketing",
    "community",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification"
  ],
  "release_year": "2005",
  "integration_partners": [
    "HealthEdge Software"
  ],
  "id": "SW1462",
  "slug": "prospective-payment-integrity",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/prospective-payment-integrity.json"
  }
}